Adverse childhood events and insecure attachment lead to difficulties in emotion regulation and social support, predisposing individuals to post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD) when exposed to potentially traumatic events. However, the field lacks an integrated account of how these risk and protective factors combine, including the pathways through which attachment-related vulnerability contributes to trauma symptoms. This study tested a proposed intra-interpersonal vulnerability model using structural equation modelling with a sample of 706 participants (M = 30.64 years, SD = 11.00). Model fit was strong for symptoms of ICD-11 PTSD (CFI = 0.969; SRMR = 0.055) and ICD-11 CPTSD (CFI = 0.976; SRMR = 0.056). The model explained 35% of variance in PTSD symptoms and 75.7% of variance in CPTSD symptoms. Cross-validation supported the generalisability of the model, with the overall pattern of effects also replicated among participants with elevated PTSD/CPTSD symptoms. As expected, adverse childhood events were linked to attachment insecurity (e.g., β = 0.29), which influenced emotional identification, emotion dysregulation and social connectedness (β = 0.24 to β = -0.69). Contrary to expectations attachment insecurity did not impact either PTSD or CPTSD trauma symptoms directly. Emotion dysregulation was significantly associated with both PTSD and CPTSD symptoms, whereas social connectedness was associated with CPTSD but not PTSD symptoms. Overall, the results indicate that risk and protective factors build upon each other, reinforcing the importance of developmental aspects in the emergence of post-traumatic stress. Limitations include a community sample and cross-sectional data, suggesting a need for longitudinal research.
BACKGROUND:Voice-related distress has traditionally been explained by voice content and severity; however, emerging research highlights the importance of relational, social rank and gendered dynamics. This study examined whether the gender of the hearer and perceived voice gender interacted to influence distress and whether specific hearer gender-voice gender configurations were associated with heightened distress. METHOD:Assessments within routine clinical practice were completed by 347 adults referred to a UK specialist clinic for distressing voices between 2016 and 2024. Participants provided data for gender (self and main voice) and voice-related distress. Hypotheses were tested in relation to perceived voice gender, the pairing of hearer gender and voice gender and associated distress. RESULTS:Male voices were significantly more common, and men were more likely to hear male voices than women. Women who heard male voices reported the highest levels of distress. CONCLUSIONS:Voice-related distress appears to be influenced by gendered interpersonal dynamics. Women who hear male voices may be especially vulnerable and could benefit from more targeted, relationally informed support in clinical settings.
Anticipatory trauma involves extreme anxiety, mental preoccupation, bodily tension and emotional distress experienced before a potential traumatic event. Individuals may suffer from stress, worry, preparedness behaviours and impairments in social and personal functioning due to the expectation that they or their loved ones may face a significant risk, accident, attack, disaster or similar traumatic experience in the future. This study aims to develop a reliable and valid Anticipatory Trauma Scale (ATS) and examine its role within a serial mediation model among adults. The study was conducted in three stages. In Study 1 (N = 463), confirmatory factor analysis was used to validate the 10-item ATS. Reliability analyses showed that the scale had high internal consistency, while item response analysis indicated the discriminatory power of the items. In Study 2 (N = 491), correlation analysis indicated that the ATS was significantly associated with life satisfaction, the Big Five personality traits, stress, anxiety, depression and trauma coping self-efficacy. In Study 3 (N = 569), structural equation modelling demonstrated that social support and resilience serially mediated the relationship between ATS and mental well-being. Findings suggest that interventions should focus on building resilient social networks and effective coping mechanisms to support the mental health of individuals experiencing trauma and anxiety.
Narcissistic personality disorder (NPD) and pathological narcissism (PN) urgently need empirically supported treatment options. Mohajerin et al. randomized controlled trial yielded promise in addressing this gap. However, in this commentary, an international group of personality disorder experts identify a number of issues with the trial methodology, reporting and interpretation: (i) the unlikeliness that consecutive sample recruitment would result in almost equal number of participants in grandiose vs. vulnerable subgroups; (ii) the unlikeliness that consecutive sample recruitment would result in almost equal number of participating men and women; (iii) the unlikely possibility that grandiose and vulnerable narcissism would appear as uncorrelated subtypes; (iv) dissimilar treatment responses to schema-focused therapy vs. Unified Protocol; (v) absence of dropouts; (vi) unclear randomization procedure; (vii) poor screening and recruitment procedures and limited transparency in trial registration; (viii) exclusive reliance on self-report measures; (ix) limited transparency in supervision and treatment fidelity procedures; (x) nonequivalence of treatment dose and duration; and (xi) lack of clarity on how the disclosure of NPD diagnosis to participants was handled in the trial. In light of these concerns, it is difficult to reconcile the results of this trial with the inherent challenges of treating NPD and PN. We therefore warrant against considering it a benchmark in NPD treatment innovation.
INTRODUCTION:Dropout from psychotherapy for major depressive disorder (MDD) undermines treatment effectiveness for both patients and clinicians. Early identification of individuals at risk of discontinuation is therefore essential. Machine learning methods, particularly those incorporating resampling techniques to address imbalanced clinical data, may offer improved predictive capacity. This study evaluates several machine-learning approaches to determine their potential in identifying patients at elevated risk of dropout. METHODS:Data were drawn from a randomised controlled trial of outpatients with MDD (n = 290) receiving short-term psychodynamic supportive psychotherapy (SPSP) or cognitive behavioural therapy (CBT). Candidate predictors were restricted to variables available in both the development and external validation datasets, resulting in a limited number of overlapping predictors. Multiple machine learning models and resampling strategies were applied to predict dropout, and the best-performing models were subsequently externally validated using an independent clinical dataset (n = 96). RESULTS:Models demonstrated low predictive performance overall. Resampling strategies influenced outcomes, with SMOTE consistently improving F1-scores compared with no resampling. The combination of random forest with SMOTE achieved the highest F1-score (0.303). Five key predictors of dropout emerged: younger age, unemployment, a higher number of comorbid Axis I disorders, absence of a partner, and moderate depression severity. All models showed reduced performance during external validation. DISCUSSION:The models showed very limited predictive performance, which may in part reflect the restricted predictor set resulting from the requirement that variables be assessed in both trials. While clinical application is premature at this stage, the findings provide a valuable proof of concept and highlight key methodological challenges inherent in cross-trial dropout prediction. Despite this, the identified predictors are routinely available in clinical practice, suggesting that future models, if developed with richer predictor sets and validated in larger samples, could ultimately support therapists in the early identification of patients at risk of dropout and in proactively addressing disengagement.
Rumination and daily affect play important roles in the development of transdiagnostic mental disorders. However, little is known about the dynamic associations between grief rumination and daily affect in bereaved individuals' everyday lives. This study used ecological momentary assessment (EMA) to examine reciprocal temporal associations between grief rumination and daily negative and positive affect (NA and PA). Sixty-one bereaved individuals completed EMA surveys four times daily for 14 days, yielding 3227 valid observations. Results from residual dynamic structural equation modelling (RDSEM) revealed reciprocal temporal associations between overall grief rumination and NA. Initial analyses further suggested higher-than-expected levels of NA predicted subsequent higher brooding, whereas higher-than-expected levels of reflection predicted subsequent higher NA. Sensitivity analysis controlling for baseline trait rumination or time since loss revealed significant bidirectional lagged associations between NA and overall grief rumination, brooding and reflection. No significant lagged associations were found between grief rumination and PA, but the contemporaneous associations were significant and negative. The results advance understanding of the emotional dynamics of grief rumination and suggest that bereavement interventions may benefit from targeting both rumination and negative affect.
OBJECTIVE:Borderline personality disorder (BPD) and eating disorders (EDs) frequently co-occur and are associated with heightened clinical severity and emotion dysregulation. This systematic review aimed to synthesize empirical evidence on the effectiveness of dialectical behaviour therapy (DBT) in improving eating disorder outcomes among individuals with comorbid BPD and EDs. METHOD:A systematic literature search was conducted across Wiley, Web of Science, SpringerLink and Scopus databases in accordance with PRISMA 2020 guidelines. Studies were included if they examined DBT-based interventions in samples with comorbid BPD and EDs and reported quantitative outcomes. Eight studies met inclusion criteria. Risk of bias was assessed using Joanna Briggs Institute (JBI) checklists, and a structured narrative synthesis was performed. RESULTS:Across studies, DBT-based interventions were associated with reductions in eating disorder symptom severity, maladaptive eating behaviours (e.g., binge eating and purging) and self-harm. Baseline BPD symptom severity did not consistently predict poorer outcomes and, in some cases, was associated with greater early improvements. However, substantial heterogeneity in study design, sample characteristics and outcome measures was observed, and methodological quality varied across studies. CONCLUSIONS:DBT appears to be a clinically relevant and promising transdiagnostic intervention for individuals with comorbid BPD and EDs. Nevertheless, the current evidence base is limited by methodological constraints, highlighting the need for well-designed randomized controlled trials and mechanism-focused research. These findings have important implications for clinical practice, supporting the use of DBT as a transdiagnostic intervention in complex comorbid populations.
Understanding when and who is at greater risk of dropping out can help therapists and mental health professionals develop strategies to keep clients engaged, thereby improving the overall effectiveness of therapy. In the present study, we aimed to explore the hazard of dropout, both early and late in treatment, and evaluate the predictive power of both static (i.e., baseline client characteristics) and dynamic predictors (i.e., treatment process variables), in a sample of 97 clients treated with the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders. Thirty-one clients (31.96%) discontinued treatment, with the highest dropout rate observed at the end of Session 4. Stratified Cox modelling showed a significant effect of younger age β 1 = - 1.706 , p = 0.031 , non-student status β 2 = - 1.715 , p = 0.031 and higher baseline anxiety severity β 3 = 1.806 , p = 0.022 , on the risk of dropping out until Session 4 (i.e., the early phase of treatment). Beyond Session 4, only lower depressive severity measured at intake began to significantly affect the risk of dropout β 8 = - 1.007 , p = 0.034 . Additionally, joint modelling (JM) of survival and longitudinal data for the early phase of treatment provided evidence of the predictive power of lower distress levels γ 01 = - 0.181 , p = 0.093 and lower therapeutic alliance quality γ 02 = - 0.137 , p = 0.05 on the clients' decision to discontinue treatment prematurely. After Session 4, no factor showed a significant association with dropout risk within the JM approach. The results suggest that early sessions are critical for the client's retention, and the JM approach is indispensable for studying psychotherapy dropout, especially in the context of endogenous time-varying predictors. Implications for clinical and research contexts are discussed.
Direct trauma exposure (DTE) affects both emotional and cognitive functioning, yet the mechanisms linking DTE to anxiety remain insufficiently understood. A community sample of 574 adults completed measures of state anxiety, executive function difficulties (EFD) and emotional entitlement following war-related DTE. Results indicated that DTE participants reported higher anxiety and EFD, lower levels of positive and uncompromised entitlement compared to non-exposed participants. EFD was positively associated with anxiety, and DTE was indirectly associated with anxiety through EFD, reflecting an indirect-only mediation pattern. The indirect effect of DTE on anxiety via EFD was significant only at low and average levels of positive and negative entitlement, as higher positive and negative entitlement attenuated the DTE-EFD association. These findings highlight perceived EFD as a key mechanism linking DTE to anxiety and suggest that fostering adaptive forms of emotional entitlement may serve as an important resilience factor to reduce anxiety in the aftermath of trauma.
This study estimated the prevalence of probable depression among parents and primary caregivers of children and adolescents with specific learning disorders (SLDs) in Saudi Arabia and developed explainable machine-learning models for screening-oriented classification. In this multicentre cross-sectional study, 612 caregivers were recruited through clinical, psychoeducational, educational and community pathways. Children had formally documented SLD diagnoses established through qualified clinical, psychoeducational, school psychology or multidisciplinary services. Probable depression was defined as a Patient Health Questionnaire-9 score of 10 or higher. Forty-seven candidate predictors covered parent, child, family, psychosocial, socio-economic, stigma-related and service-access domains. Elastic-net logistic regression, random forest, XGBoost, LightGBM and a soft-voting ensemble were evaluated using stratified 10-fold cross-validation. Probable depression was identified in 218 participants (35.6%; 95% CI 31.8-39.6). XGBoost and the soft-voting ensemble achieved the highest ROC AUC (0.916); XGBoost yielded an average precision (AP) of 0.867 and a Brier score of 0.115. At a screening-oriented threshold of 0.425, XGBoost achieved sensitivity of 0.858, specificity of 0.830 and negative predictive value of 0.913. SHAP analyses identified parenting stress, parental anxiety symptoms, sleep quality, SLD severity, child emotional and behavioural difficulties, perceived social support and coping capacity as the most influential predictive features. Probable depression was common in this service- and community-recruited sample. Explainable models may support family-centred identification and referral, but external evaluation is required before implementation.
This study examined therapists' assessments of post-traumatic stress disorder (PTSD) symptoms and disturbances in self-organization (DSO), the additional symptom cluster that distinguishes complex PTSD (CPTSD) from PTSD in ICD-11. We investigated how these dimensions, together with patient dissociation, shape therapists' affective responses and in-session disconnection, considering both patient (CADS; observer rated) and therapist (DES; trait) dissociation. Therapists (N = 60) completed measures referring to one selected patient. Measures included PTSD and DSO symptoms, personality organization, self-concept clarity, adverse childhood experiences, interoceptive awareness, patient dissociation, therapist affective responses, therapist dissociation and therapist in-session disconnection. Correlational analyses, MANOVA and hierarchical regressions were conducted. DSO and PTSD showed distinct profiles of functioning. DSO was associated with broader structural vulnerabilities, including impaired personality organization, adverse childhood experiences, reduced interoceptive awareness and higher dissociation, whereas PTSD was primarily associated with reduced self-concept clarity. DSO predicted therapists' feelings of helplessness, whereas patient dissociation predicted overwhelmed/disorganized responses and reduced positive engagement. Patient dissociation and therapist dissociation independently predicted therapists' experiences of in-session disconnection, while their interaction was not significant. Findings highlight distinct relational correlates of DSO and PTSD and identify dissociation as a central mechanism of therapeutic disconnection. Dissociation operates as a shared field phenomenon, with clinical implications for monitoring and addressing in-session relational 'drifts'.
Impairments in interpersonal functioning are a core transdiagnostic feature of personality disorders (PDs). While interpersonal problems are known to worsen clinical outcomes, their mediating role between PDs and mental health requires further empirical examination. The study aims were: (1) to analyse gender differences in PDs, mental health and interpersonal problems; (2) to study the correlations between study variables; and (3) to examine the mediating role of interpersonal problems in the relationship between PDs and global mental health. The final sample comprised 291 participants (Mage = 38.30, SD = 13.80; 66.3% women) from a clinical population who completed the International Personality Disorder Examination (IPDE), the Inventory of Interpersonal Problems (IIP-32) and the Symptom Checklist (SCL-90). Women scored higher on the self-sacrificing dimension (p = 0.023), and a significant gender difference was also found for narcissistic personality disorder, with men scoring slightly higher than women (p = 0.048). Higher scores on PDs and greater interpersonal difficulties were strongly associated with mental health problems (ρ-values between 0.467 and 0.571). Finally, interpersonal problems mediated the association between personality cluster scores and mental health problems. Interpersonal problems, PDs and mental health symptoms form an interlinked pattern of psychological distress. Consequently, therapeutic interventions for PDs must prioritize the modification of maladaptive relational styles with the aim of preventing or mitigating co-occurring mental health problems.
BACKGROUND:This study examined the effects of Group Interpersonal and Social Rhythm Therapy (IPSRT) on suicide-related interpersonal constructs (perceived burdensomeness and thwarted belongingness as proxy indicators of suicidal risk) and mood symptoms in patients with bipolar disorder. METHODS:In this quasi-experimental study, 36 patients with bipolar I or II disorder were recruited from psychiatric centres in Isfahan, Iran, and randomly assigned to an experimental group (n = 18) or a control group (n = 18). The experimental group received 12 weekly group sessions of Group IPSRT in addition to standard pharmacotherapy, whereas the control group received pharmacotherapy alone. Suicidal ideation was assessed using the STS-IPTS, and mood symptoms were measured using the Persian version of the Mood Disorder Questionnaire (MDQ). Assessments were conducted at pretest, post-test and follow-up. Data were analysed using repeated-measures ANOVA and MANOVA. RESULTS:Significant time × group interaction effects were found for suicidal ideation, F(1.53, 51.90) = 43.09, p < 0.001, η2 = 0.56, and for perceived burdensomeness, F(2, 68) = 39.75, p < 0.001, η2 = 0.54. Participants receiving IPSRT showed a marked reduction in perceived burdensomeness and thwarted belongingness that was largely maintained at follow-up. For mood symptoms, a significant time × group interaction was found, F(1.68, 57.05) = 12.93, p < 0.001, η2 = 0.28, with the strongest improvements observed in goal-directed behaviour. CONCLUSIONS:Group IPSRT appears to be an effective adjunctive intervention for reducing suicidal ideation and improving selected mood symptoms in individuals with bipolar disorder.
This study examined the role of perceived stress in intervention-related change during a mindfulness-based intervention (MBI) for emotional distress across two randomized controlled trials. In Study 1, 636 participants (Mage = 31.06, SDage = 9.54; 83.18% female) with high psychological distress were randomized to an MBI group (N = 318) or a Waitlist control group (N = 318), measuring perceived stress, anxiety and depression at baseline and postintervention. Study 2 randomized 607 participants (Mage = 30.13, SDage = 8.15; 82.08% female) with high psychological distress to an MBI group (N = 304) or a Waitlist control group (N = 303), with the same measurements at baseline, Week 3, Week 5 and postintervention. In both studies, linear mixed-effects models showed greater reductions in all variables in the intervention group than in the Waitlist control group. In Study 1, simple mediation analyses showed changes in perceived stress accounted for part of the intervention-related reductions in anxiety and depression. In Study 2, parallel process latent growth curve models indicated that changes in perceived stress accounted for substantial proportions of the intervention effects on anxiety and depression. Random intercept cross-lagged panel models further suggested that perceived stress functioned as a temporally prior process particularly for subsequent depression, whereas the temporal association with anxiety was more bidirectional. Perceived stress may represent an important process underlying the MBI effects on emotional distress, especially in reducing depression. Early reductions in perceived stress may help identify subsequent improvement in anxiety and depression. Trial Registration: Study1: Chinese Clinical Trial Registry number: ChiCTR2200057398. Study2: Clinical Trials number: NCT06035003.
This study analyses gender-based violence in women over 50, focusing on its psychological repercussions and suicide risk. Based on the invisibility of this population in public and scientific discourse, the research examined abusive dynamics in intimate relationships and their consequences for victims' mental, social and emotional health. A cross-sectional quantitative study was conducted with 120 Portuguese women with a history of domestic violence. Four validated instruments were applied: the Questionnaire of Emotional Response to Domestic and Sexual Violence, the Domestic Violence Scale, the Plutchik Suicide Risk Scale and the Scale of Beliefs about Conjugal Violence. Results showed psychological, gender and social violence as the most prevalent forms, whereas sexual violence was least identified. Participants presented medium-high levels of emotional symptomatology, particularly irritable mood, depressive symptoms and social maladjustment. Significant associations emerged between suicide risk and emotional variables such as anxiety and irritability. Legitimization of violence, especially linked to family preservation or external causes, was also associated with suicide risk. Findings highlight the urgent need for public policies and tailored interventions to mitigate long-term consequences of violence and promote older women's well-being.
BACKGROUND:Although impulsivity is commonly associated with eating disorders (EDs) comorbid with self-harm, no prior reviews have investigated whether ED groups with co-occurring self-harm exhibit increased impulsivity-related traits. OBJECTIVE:This systematic review and meta-analysis synthesized the differences between ED groups with vs. without self-harm/suicidal behaviour, with respect to impulsivity-related domains. METHOD:Following the PRISMA 2020 guidelines, we searched for comparative observational studies using electronic databases, reference lists, personal reference collection and requests sent to authors in the field for unpublished data. We included studies conducted from 1994 onwards that compared clinical ED groups with vs. without self-harm/suicidal behaviour on impulsivity-related domains, as assessed using questionnaires. We used a two-stage screening process conducted by independent reviewers and the Joanna Briggs Institute's tool for risk of bias assessment. Results were synthesized narratively and quantitatively, using separate random-effects meta-analyses for each impulsivity-related domain. RESULTS:According to meta-analytic results, clinical ED groups with self-harm/suicidal behaviour exhibited significantly increased scores on Negative Urgency (k = 10, g = 0.55), Lack of Premeditation (k = 8, g = 0.34), Lack of Perseverance (k = 8, g = 0.20) and Sensation Seeking (k = 8, g = 0.10). Only two studies assessed Positive Urgency, both reporting non-significant differences. CONCLUSION:Negative Urgency emerged as the prime impulsivity-related trait associated with self-harm in ED groups, therefore strengthening the evidence for emotion-driven impulsivity as a transdiagnostic factor of psychopathology. The small number of studies included, considerable heterogeneity and predominance of female samples should be taken into account when interpreting current findings.
Emotional communication is central to psychotherapy and plays a key role in shaping clients' experiences and therapeutic change. Conversation analysis (CA) offers a process-oriented approach to examining how emotions are displayed, managed, and responded to in moment-by-moment therapeutic interaction. Although a growing line of CA research has focused on emotion talk in psychotherapy, an integrative synthesis of this literature remains limited. This review synthesizes CA studies on emotion talk in psychotherapy, with a focus on identifying key interactional processes through which emotion talk is produced and managed in naturally occurring therapeutic encounters. Following PRISMA guidelines, we searched six major databases and identified 18 studies that met the inclusion criteria. The thematic analysis revealed two overarching themes: (1) the sequential organization of emotion talk, including clients' emotional displays, therapists' emotional management, and clients' responses; and (2) changes in therapeutic interaction, encompassing shifts in clients' emotional experiences and the therapeutic relationship over time. By integrating CA studies on emotion talk in psychotherapy, the review clarifies the interactional resources through which therapists and clients navigate emotional moments. These findings advance understanding of psychotherapy as an interactional achievement and offer practice-relevant insights into how therapists can attend to and work with clients' emotions to support further therapeutic work.
The feasibility of psychological interventions should be considered when developing and evaluating new therapy methods. Indicators of low feasibility may be a high dropout rate, a low attendance rate and low treatment satisfaction, which threaten the validity of clinical research studies. Given the severity and chronicity of bipolar disorder and its impact on psychosocial functioning, effective treatments are needed to alleviate depressive and manic symptoms. The study evaluated the feasibility and preliminary treatment effects of a novel disorder-specific metacognitive group training for bipolar disorder (MCT-Bipolar), which targets cognitive biases specific to depressive and manic episodes while also incorporating mindfulness techniques. Forty-eight outpatients with bipolar disorder I and II participated in the training conducted by a clinical psychologist for eight consecutive weeks in groups of six to 10 people. Inclusion criteria were euthymia or mild or moderate depressive symptoms. Predictors of dropout and attendance rates were analysed using regression methods, and secondary exploratory analyses examined changes in various efficacy indicators between baseline, 1 week after training and 6 months after training using linear mixed models. In total, 10 participants (20.8%) dropped out, while completers attended an average of six out of eight sessions. Treatment satisfaction of the completers was high. Linear mixed models revealed an increase in mindfulness from baseline to follow-up. Results on psychosocial functioning showed an increase from baseline to post-training, though this effect disappeared at the 6-month follow-up. Findings support the feasibility of MCT-Bipolar and suggest potential benefits for mindfulness and short-term psychosocial functioning. Further research with larger samples and a control group is needed to assess its efficacy. Trial Registration: The evaluation study is registered in the German Registry of Clinical trials (DRKS, registration number DRKS00035704) and received approval from the ethical committee of Charité - University Hospital Berlin (No. EA1/076/22).
BACKGROUND:The underuse of psychosocial care services by migrants from Southwest Asian countries residing in countries of the global north warrants systematic investigation. Literature suggests that this underutilization reflects not only structural barriers such as language difficulties, but also more negative attitudes toward seeking professional psychological help compared to residents of Western countries. However, systematic comparisons of such attitudes among individuals with a Turkish migration background in Germany, Turks in Turkey and Germans without a migration background are scarce. Drawing on the Theory of Planned Behaviour, the present study additionally examined stigma, perceived social support, male role norms and relevant sociodemographic covariates as potential factors associated with help-seeking attitudes. METHOD:This online cross-sectional study compared attitudes toward seeking professional psychological help and relevant predictors among these three groups (N = 942; n = 296 Germans, n = 271 Turkish migrants, n = 375 Turks in Turkey). RESULTS:Turkish migrants reported more negative attitudes than Turks in Turkey. There were no differences in the attitudes between Turkish migrants in Germany and Germans. Stigma and male role norms were negatively associated with attitudes toward help-seeking and partially accounted for group differences. Perceived social support showed no consistent effects. CONCLUSION:Attitudes toward seeking professional psychological help among Turkish migrants and Turks appear to be more complex than initially predicted. Findings are consistent with the Theory of Planned Behaviour assumptions, suggesting that culturally shaped subjective norms, particularly male role beliefs, may be more central in explaining help-seeking attitudes than group membership alone.
High symptom heterogeneity in obsessive-compulsive disorder (OCD) confounds clinical and research progress. Two notable models organize symptoms dimensionally. The first is a four-factor model describing manifest symptoms related to germs/contamination, harm/injury/bad luck, unacceptable thoughts and symmetry. The second describes two core emotional-motivational dimensions of harm avoidance (HA) and incompleteness (INC). Research comparing these models has typically been limited by the use of measures that either do not assess manifest symptoms using the four-factor model framework or do not adequately support continuous dimensional scoring. Utilizing a voluntary, non-incentivised adult community sample with lifetime OCD diagnoses, this study explored relationships between both models using measures purposefully designed to assess each, and that employ comparable dimensional operationalizations-the Dimensional Obsessive-Compulsive Scale and the Obsessive-Compulsive Core-Dimensions Questionnaire-Trait. Regression analyses showed HA and INC to be moderate predictors of overall symptom severity and unique predictors of different manifest symptom dimensions. HA predicted symptoms relating to harm/injury/bad luck and unacceptable thoughts, whereas INC predicted symptoms relating to germs/contamination and symmetry. Our findings indicate that the core dimensions help to explain and organize patterns in OCD symptom heterogeneity and add to the growing evidence that they are candidate endophenotypes. To our knowledge, this is the first study to examine associations of the manifest symptom and core dimension models in a community sample of individuals with lifetime OCD. Conceptual and clinical implications, including those of continued refinement of symptom models for OCD, are discussed.
